应用二维斑点追踪显像和压力-应变环评价左室射血分数保留的重度主动脉瓣狭窄患者经导管主动脉瓣置换术后的左室心肌功能

Evaluation of left ventricular myocardial function after transcatheter aortic valve implantation in severe aortic stenosis patients with preserved left ventricular ejection fraction by two-dimensional speckle tracking imaging technology and pressure-strain loop

目的联合应用二维斑点追踪(2D-STI)技术和左室压力-应变环(PSL)对左室射血分数(LVEF)保留的重度主动脉瓣狭窄(AS)患者经导管主动脉瓣置换术(TAVI)后左心室心肌应变和整体心肌做功指数进行定量评估。方法选取2020年1-11月在厦门大学附属心血管病医院住院的LVEF保留的重度AS拟行TAVI的患者20例为TAVI组,选取同期性别、年龄相匹配的健康成年人20例为对照组,采用2D-STI获取左室整体纵向应变(GLS),心内膜层、中层、心外膜层心肌纵向应变(LSendo、LSmid、LSepi),分析心导管测量的主动脉压、有创左心室收缩压分别与血压、用外周肱动脉收缩压结合主动脉瓣平均跨瓣压差的无创左心室收缩压的相关性,应用无创PSL评估左室整体做功指数(GWI)、整体有用功(GCW)、整体无用功(GWW)、整体做功效率(GWE),比较TAVI组术前与对照组以及TAVI组术前、术后1周、术后3个月左室心肌应变和心肌做功的差异。结果TAVI组术前GLS、LSendo、LSmid、LSepi较对照组降低(均P<0.05),术后1周LSendo提高,术后3个月GLS、LSendo、LSmid、LSepi增高(均P<0.05)。TAVI术前有创测量的主动脉压与无创测量的外周肱动脉收缩压、有创测量的左心室收缩压与无创预估的左心室收缩压呈正相关(r=0.658、0.565,均P<0.01)。与对照组比较,TAVI组术前GWE降低,GWW增高(均P<0.05)。与TAVI组术前相比,术后1周GWI、GCW降低(均P<0.05);与术后1周相比,术后3个月GWI、GCW、GWE增高,GWW降低(均P<0.05)。结论联合应用2D-STI和PSL可定量评估重度AS患者TAVI手术前后的左室心肌收缩功能,为临床评价TAVI疗效提供了更为客观的参考指标。

Objective To quantitatively evaluate the left ventricular myocardial strains and global myocardial work indices in severe aortic stenosis(AS)patients with preserved left ventricular ejection fraction(LVEF)undergoing transcatheter aortic valve implantation(TAVI)by using two-dimensional speckle tracking imaging(2D-STI)technology and pressure-strain loop(PSL).Methods Twenty patients undergoing TAVI from January to November 2020 in Cardiovascular Hospital of Xiamen University were selected as the TAVI group,and 20 healthy volunteers(with the matched gender,age)were selected as the control group at the same period.Left ventricular global longitudinal strain(GLS),endocardial,middle,epicardial myocardial longitudinal strain(LSendo,LSmid,LSepi)were measured by 2D-STI.The correlation between aortic pressure and the left ventricular systolic pressure invasively measured by cardiac catheterization,and blood pressure and the left ventricular systolic pressure non-invasively measured by peripheral brachial artery systolic blood pressure combined with Doppler-derived mean aortic gradient was separately compared.The non-invasive PSL was used to evaluate the global work index(GWI),global constructive work(GCW),global wasted work(GWW)and global work efficiency(GWE).The differences of the myocardial strains and myocardial work indices between the two groups,including controls,patients with preoperation,1 week and 3 months after TAVI,were compared.Results Compared with the control group,GLS,LSendo,LSmid and LSepi of the left ventricle in the TAVI preoperation group were decreased(all P<0.05),LSendo increased at 1 week after TAVI,and GLS,LSendo,LSmid,and LSepi increased at 3 months after TAVI(all P<0.05).In the TAVI preoperative,invasive aortic pressure was positively correlated with peripheral brachial artery systolic blood pressure,invasive left ventricular systolic pressure was positively correlated with non-invasive left ventricular systolic pressure(r=0.658,0.565;all P<0.01).Compared with the control group,the preoperative the GWE decreased and the GWW increased in the TAVI group(all P<0.05).Compared with the preoperation,the GWI and GCW decreased at 1 week after TAVI(all P<0.05).Compared with 1 week after TAVI,GWI,GCW,GWE increased and GWW decreased at 3 months after TAVI(all P<0.05).Conclusions The application of 2D-STI and PSL can quantitatively evaluate the left ventricular myocardial systolic function before and after TAVI in AS patients,which can provide a more objective reference index for clinical evaluation of the efficacy of TAVI.